The failed posterior lumbar interbody fusion

The problems presented by unsuccessful posterior lumbar interbody fusion (PLIF) have not been addressed. The cases of 12 patients who presented with failed PLIF were reviewed. Five patients were male and seven female (age range, 24-50 years; mean age, 40 years). All patients underwent at least one PLIF; many had undergone other procedures. A total of 37 procedures had been performed on the 12 patients. Chronic radiculopathy was present in all patients, as detected with electromyographic or nerve conduction velocity examination. At the time of reconstructive surgery, in the 11 patients in whom the canal was explored, all had extensive epidural fibrosis. Nine of the 12 patients had pseudarthrosis of the previous PLIF. Four patients had evidence of motion segment dysfunction at nearby levels: two had positive discograms adjacent to the PLIFs; one developed a facet syndrome at L5-S1, caudal to an L4-5 PLIF; and one demonstrated frank segmental instability at L2-3, cranial to a previous PLIF at L3-4. Twelve patients underwent a total of 22 procedures after referral. Eleven patients initially underwent decompression and fusion, and one patient underwent a sympathectomy. Seven patients underwent an additional 10 procedures, including repeat decompression, repair of pseudarthrosis, and implantation of an epidural analgesic pump system. After all surgical treatment, five patients rated their pain as improved. Seven patients were thought to have a solid fusion. The presence of a solid fusion did not correlate with satisfactory relief of pain (chi-square). Continued extremity pain was the predominant complaint of all the patients. Two shortcomings of the PLIF were evident.(ABSTRACT TRUNCATED AT 250 WORDS)